Medicaid Work Requirement Bill Sent to Michigan Governor

The Republican-led Michigan Legislature on Thursday gave final approval to a bill requiring able-bodied adults in the state's Medicaid expansion program to meet work or job-related requirements, sending it to Gov. Rick Snyder for his expected signature.

Starting in 2020, adults age 18 to 62 would have to show workforce engagement averaging 80 hours a month — through work, school, job or vocational training, an internship, substance abuse treatment or community service. Michigan would first seek a federal waiver to implement such requirements that have been embraced by President Donald Trump's administration.

About 540,000 of 670,000 enrollees in the Healthy Michigan plan could be affected because they would not qualify for various exemptions. Several other GOP-led states have already tied work requirements to Medicaid eligibility.

Michigan's expansion program provides health insurance to adults with incomes at or below 133 percent of the federal poverty level.

Senate Republicans approved the legislation 25-11, with two GOP senators joining Democrats in opposition. The measure also would changes rules for Medicaid enrollees once they have been in the expansion program for four years. They currently are being shifted to health exchanges created under President Barack Obama's federal health care law. Under the bill, they could remain on Medicaid but would have to pay 5 percent of their income as a premium and to complete healthy behaviors.

Michigan's Medicaid expansion would end if the federal government does not approve the waivers within a year of them being submitted.

Of the 540,000 who would be subject to the work requirements, 5 percent to 10 percent — or 27,000 to 54,000 — could lose coverage, according to estimates.

One Democrat, Sen. Coleman Young II of Detroit, called the bill "draconian," a "twisted joke" and said it is a "turd." Another, Sen. Rebekah Warren of Ann Arbor, said "no amount of exemptions or allowances would be enough to make this bill something I could support."

Republicans defended the legislation.

"This is all about trying to find more workers," said the sponsor, Sen. Mike Shirkey of Clarklake. "We have on obligation to review on a pretty regular basis all of our policies, all of our laws, all of our statutes that may unintentionally may result in disincentives to engage in the workplace. Right now, every business owner I know is seeking and searching for workers."

Groups advocating against the bill urged Snyder to veto it. But the Republican governor, who strongly supports the Medicaid expansion, said in a statement the deal on work requirements "ensures the continuation and sustainability of the Healthy Michigan program."

While opponents warned that the bill would let the Trump administration end the expansion and take away health care from recipients by not blessing the waivers, a Snyder spokeswoman said he is confident they will be approved after he personally met with officials from the Centers for Medicare & Medicaid Services in Washington, D.C., last month.

The Republican-led Michigan Legislature on Thursday gave final approval to a bill requiring able-bodied adults in the state's Medicaid expansion program to meet work or job-related requirements, sending it to Gov. Rick Snyder for his expected signature.